Provider Demographics
NPI:1336600709
Name:BURR, GARRETT JAMES
Entity Type:Individual
Prefix:
First Name:GARRETT
Middle Name:JAMES
Last Name:BURR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6129 CHESEBRO RD
Mailing Address - Street 2:
Mailing Address - City:AGOURA
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1833
Mailing Address - Country:US
Mailing Address - Phone:818-584-5577
Mailing Address - Fax:
Practice Address - Street 1:509 MARIN ST STE 135
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-7897
Practice Address - Country:US
Practice Address - Phone:805-379-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician